Editor’s Note: Many times we on the staff have heard a patient say, “Oh, I wish I could have sat with Dr. Lieberman for hours-I learned so much!” In this “chair-side chat,” Dr. Lieberman explores the connection between yeast and developmental delays, food allergies, asthma, and even prostatitis.

Q: What has made this field of yeast-related illness so timely for several decades now?

Dr. Lieberman: When I first started working in this field in the late 1970’s, I thought every patient had yeast, and I treated everybody accordingly. After awhile I got disillusioned and I said, “No, this is impossible, nobody has it!” As the years went by, the pendulum swung back again. If you’re an astute clinician and you talk to patients, you see that yeast is a problem.

The paper presented by Dr. William Shaw at one of the American Academy of Environmental Medicine conferences in Kansas City was the real bombshell, because it gave us, for the first time, really hard evidence that many physicians were right who talked about yeast as a major cause of impairments.

Q: What was Shaw’s background and why did he get interested in this himself?

Dr. Lieberman: Dr. Shaw, as an analytical biochemist, was analyzing the urine of two brothers. He didn’t know anything about these children, except that once the results came from the laboratory, he had never seen the presence of these particular metabolites before. He said, “These are not normal metabolites of normal people,” and ultimately realized that they were metabolites of bacteria and fungi. When he inquired about the children he had tested, he found that they both were autistic. So then he started to look at the urine of other children with autism and other neurologic problems, and lo and behold, he found that their urine also contained the same metabolites. That was really the great breakthrough-the presence of yeast and abnormal bacteria produce identifiable chemicals in the urine.

With Shaw’s paper, we now had a scientific basis to show, beyond a shadow of a doubt, that a patient can have these organisms and be influenced by the metabolites of them.

Dr. Lieberman: To me, the most amazing thing is to look at levels of yeast metabolites in the urine of children who have been on antibiotics for their ear infections. We wonder what happens to these kids-why their behavior changes and why they develop all kinds of problems-and there it is. Shaw’s contribution has been not only to identify yeast metabolites as a cause of neurologic problems, but also to show an imbalance in the gut bacteria can produce abnormal metabolites. The imbalance of the gut flora is called dysbiosis.

Q: In what way does a bowel dysbiosis or yeast overgrowth actually manifest? How does that impact upon the brain?

Dr. Lieberman: Small molecules have the capacity to go through the blood-brain barrier and it seems that they are amazingly capable of altering cerebral function. We know, for example, that in digesting and metabolizing wheat and other grains containing gluten, certain types of opioids can be produced and these things can really affect brain function. Well, now we see that organic acid molecules that are coming from yeast and bacteria are also capable of crossing the blood-brain barrier and influencing behavior and brain function.

Q: And that might show up as autism, or hyper-activity, or other neurologic problems?

Dr. Lieberman: When I’ve talked with Dr. Shaw, he said he’s seeing a lot more of these organic acid metabolites in the urine of hyper-active children. That doesn’t surprise me in the least. There is an epidemic of these problems in children. They’re sick all the time and why are they sick all the time? It is because of their diet, food sensitivities, and the development of secondary dysbiosis problems with either yeast or bacteria that produce these metabolites. The metabolites are actually causing behavior problems.

Q: So he has seen a reversal in the problems of the patients who have been treated on the basis of his Organic Acids Urine Test?

Dr. Lieberman: When Dr. Shaw found these unusual metabolites in the urine of the brothers, he asked the parents, “Why don’t we put these children on some anti-fungal drug and see what happens?”

With anti-fungal treatment, the yeast metabolites in the children’s urine decreased and their behavior improved.

So we have a very wonderful cause and effect relationship. Of course, it takes more than treatment of yeast to clear all behavior problems, but this can be a critical piece in the treatment program.

Q: And you’ve seen a change in the behavior of those you’ve treated, too?

Dr. Lieberman: Yes, definitely. As you read our Testimonials from successfully treated patients or their parents, you see that treatment of yeast has made a huge difference in behavior in many cases.

Q: Does dysbiosis or yeast overgrowth cause other problems besides changes in behavior?

Dr. Lieberman: Dysbiosis is actually an imbalance of all the microbiological flora of the gut, not just a yeast overgrowth. Dysbiosis produces a permeability dysfunction so that things that should remain in the G.I. tract are now getting through the wall in bigger pieces. Bigger pieces are more antigenic, meaning they are capable of producing an immunologic response, especially an allergic response. That’s how we think the mechanism of food sensitivity is being created. The more antigens from a permeable gut enter the circulation, the more immune response would be initiated. A permeable gut, which can be caused by dysbiosis, does make the problem of food allergy much worse.

In addition, once the antigen enters the circulatory system, it’s carried to all the organs of the body and comes into contact with those elements of the immune system called lymphocytes. If the antigen triggers lymphocytes and immune response in the lung, it might set off asthma. If the antigen triggers an immune response from the lymphocytes in the Peyer’s Patches of the G.I. tract, it might trigger diarrhea. It usually takes a combination of insults for the organ to react, so that is why we say in Environmental Medicine, “The previously injured organ becomes the target of the allergic response.”

Depending upon a person’s family history and medical history, any organ might be the target and produce adverse symptoms.

But what is important here for our discussion is that if yeast is a root cause of gut permeability or food allergy or other symptoms, we can confirm the presence of the yeast through Shaw’s test for the metabolites of yeast and bacteria. Now we don’t have to be defensive in trying to present this whole yeast connection concept to the scientific community.

Q: And if you don’t find the metabolites of yeast, is that the end of it?

If the metabolites of yeast are not there on testing, then we have to rethink the whole thing. I would like to address this for a minute. We all see these patients who come into the office who are totally convinced that all their problems are coming from yeast. They have literally put themselves through a mangle-there isn’t any anti-fungal drug that they haven’t been on, there’s nothing that they haven’t tried, and they feel that they’re still full of yeast. In many ways, we now have some nice criteria to say with confidence to a patient, “There is a problem, but it’s not yeast, and we have to look elsewhere. Trying to do only yeast eradication cannot be the total answer to the problem you have.”

Q: What other conditions would mimic those symptoms that a patient would think were caused by yeast?

Dr. Lieberman: That’s an interesting question, because when you’re a medical student and you’re taking the course called “Medicine,” you’ve got this textbook that has almost 2,000 pages. You say, “Okay, what are the signs and symptoms of this disease and that disease?” You find they’re often the same!

That is what makes Environmental Medicine so unique, because we’re not interested in choosing an organ and just identifying the signs and the symptoms.

The only thing that makes any difference is what causes those signs and symptoms, and what you’re going to find is that there are many ways to produce headache and the flu-like symptoms in a patient. They can come from anything from A to Z, usually a combination of things. But one of those causes is often Yeast. It doesn’t matter if yeast is affecting the nervous system, the G.I. system, or the joints. If yeast is a cause and you treat it, it’s astounding the myriad of signs and symptoms that can respond in that patient.

Q: What would be the treatment for yeast overgrowth, and is there any rule of thumb about how long treatment should be continued?

Dr. Lieberman: In our practice, we’ve always used a rather classical approach with systemic anti-fungal drugs and local-acting fungal drugs, often combined. With this approach we can treat the reservoir of yeast in the gut with the local-acting fungal drugs, but also treat elsewhere in the body where yeast may have been able to migrate due to a permeable gut or impaired immune system that didn’t keep the yeast localized. It depends upon the patient as to how long the treatment has to be applied.

For example, interestingly, many cases of chronic prostatitis in males are actually yeast prostatitis, and that’s the reason why they never get rid of the problem because they’re treated with more and more antibiotics. It’s often a combination infection of both yeast and bacteria, and until you identify which organisms are causing the infection and treat them appropriately for a sufficiently long time, the problem doesn’t resolve. We have not found cultures and stool analyses and other diagnostic tests to be entirely accurate, but with the aid of the other newer tests we use like Shaw’s test, we have very good results with many different kinds of chronic problems.

Q: Many patients seem happy to take anti-fungal medications, even expensive ones, but less inclined to follow diet changes. In your experience, what effect do anti-fungal medications without dietary changes have on the patient’s progress?

Dr. Lieberman: Well, I can answer that question because I was remiss when I first started working with these kinds of patients. I felt the diet was not the most important thing and what we needed to do was just use the drugs. What I found was that it didn’t work too well and especially there was a rebound effect after the drugs were discontinued. If you want to really try to hold these organisms down, it’s so important to stop feeding them with so many different kinds of sugars, even so-called natural sugars that are concentrated into syrups and such, and with refined carbohydrates.

Q: What happens when a person tries to diagnose himself or herself with yeast overgrowth and tries to self-treat? Can that be beneficial or harmful?

Dr. Lieberman: The question that you asked is really very relevant. Most patients will read the wonderful books by Billy Crook [William Crook M.D., who wrote the whole Yeast Connection series of books] and think, “That’s what I have!” But as I said before, if you study medicine you find that many diseases have common signs and symptoms.

I have given patients credit for being more knowledgeable than the doctor in terms of better knowing their bodies, but we gave an example before of some patients whose whole life was obsessed with the idea that they were overrun with yeast. We were able to document with these new biomarkers that it wasn’t yeast at all.

So what they did in a sense was just waste time, probably money, and effort. They were looking at the wrong cause, and that’s why they never got better. It probably takes a combination of a physician plus a patient, because the physician has to develop a more comprehensive approach and write a prescription, if necessary. Nevertheless, doctors don’t give patients enough credit for understanding their own problems, so here at our Center we try very much to respect patients when they come tell us their histories.

We have to look for the root causes of a patient’s many signs and symptoms, and a patient can’t do that on their own very often. It takes the sophistication of testing and identifying biomarkers, and with those laboratory findings, we can do a much better job of diagnosing now.

Q: So testing for these organisms is key?

Dr. Lieberman: Well, actually the most helpful testing involves looking for causes in many areas, not just hidden infection.

One other common element that needs to be thought about is the combination of allergy and hidden infection.

I’ll give you an analogy, and maybe then you can appreciate it. There was a woman who was my patient who pointed her finger at me and said, “If I touch a drop of wheat, within two hours I have a rip-roaring yeast infection. Explain that, Doctor!” The lesson that’s learned from this, of course, is that there are triggers for each individual that increase susceptibility to infection. So when necessary we also test for food, inhalant, pollen, or chemical allergies in our patients. With our allergy desensitization extracts, and also avoidance of the most severe triggers in some cases, it’s not only easier to treat hidden infections but a lasting resolution is possible. Then too, we try to build patients up through nutritional supplementation or whatever else is needed in their particular case to make the patient stronger to resist infections.

We come back to our philosophy here at the Center that you don’t just get sick, you’re made sick, and we do our best to identify what is making you sick and help you to get well again.

Dr. Billy Crook (William Crook, M.D.) wrote the Yeast Connection book in 1986. It was one of the first books published on the importance of Candida albicans on the health of men, women, and children. Everyone knew women had yeast, but few realized that yeast infection wasn’t reserved just for women.

Billy was a member of the American Academy of Environment Medicine (AAEM) and had a great deal of influence on the many like-minded physicians who recognized the environment as a major influence on health. I became a member of AAEM in 1978, which changed the course of my life in medicine.

The Yeast Connection brought down the wrath of conventional medicine upon us for treating our patients with anti-fungal medications. We had at the time only Nystatin, one of the safest drugs in the whole Physicians Desk Reference. As time went on, we learned more and more about the role of Candida albicans, as well as the development of new more potent drugs, such as Ketoconazole and Fluconazole.

As many books and medical papers have been written about yeast, it would be difficult to discuss this topic in a few paragraphs. Nonetheless, I would like to share my 33 years’ experience in this brief report.

Unbeknownst to most people, Candid albicans is part of the normal flora of our bowel. It acts as our body’s own antibiotic against enteric bacteria such as Salmonella, Shigella, and Typhoid fever. However, when we imbalance the microbiological flora of our intestine, that which is good becomes bad.

The one factor that made Candida bad was the introduction of antibiotics, which altered our healthy flora. Our use of steroids and immunosuppressive drugs also contributed to Candida’s imbalance.

Surprisingly, there are probably no signs and symptoms recorded by patients that could not be associated or caused by Candida, and the symptoms may affect every organ of the body.

The only way you can tell if Candida is the cause, in my experience, is to treat the patient empirically. There are now a few laboratory tests available which can be helpful in suspecting Candida, but even if the results are positive, you will never know if a patient’s problems are related to yeast until you treat it.

There are a few important observations I have found over the years:

1) There is clearly a relationship between endocrine function, especially the ovary and thyroid, with Candida. That is because there is molecular mimicry between Candida and the tissues of these glands.

2) One of the toughest problems in medical practice is recurrent hives. It is true that the known causes are drugs, yellow dye, food (especially natural salicylates), parasites, and hidden infection. Yet despite a patient being reactive to these many things, yeast eradication using systemic anti-fungal drugs clears the great majority of these patients’ hives.

3) A large segment of my patient population is made up of children with the Autism Spectrum Disorders. Whereas heavy metal poisoning is clearly the major cause in altering behavior in these children, yeast cannot be far behind. It never ceases to amaze me how effective systemic yeast eradication is in improving these disorders. As so many of these children have significant allergies, which leads to superimposed infections with massive recurrent use of antibiotics, the prevalence of yeast should really be no surprise. [For further information, see our companion article Yeast-Yet Again!-An Interview]

4) Diet plays a role in the support of our natural good flora-and of yeast. Diets high in simple carbohydrates do promote further yeast, so controlling its overgrowth requires reducing refined carbohydrates and simple sugars.

5) There are many alternative products that can control Candida. These include Oregano, Grapefruit Seed Extract, Olive Leaf Extract, and bicarbonate. I prefer beginning patients on Ketoconazole (Nizoral) or Fluconazole (Diflucan) first because the therapeutic trial is critical to making the diagnosis and establishing the cause. If Candida is the cause, the response is usually rapid and obvious.

6) Some patients are from Missouri and demand to be shown first that they are inhabited by massive yeast before they will start drug therapy. An Organic Acid Analysis, performed on a urine sample, may reveal presence of specific metabolites that are not of human origin. D-arabinose is specific to Candida, while Citromalic and Tartaric Acid are non-specific to other forms of yeast.

7) Finding physicians willing to test and treat problems of yeast is difficult, except for environmental physicians. The American Academy of Environmental Medicine’s website will provide their names: www.AAEMonline.com

8) There are presently numerous books on yeast, but all of the late Billy Crook’s are, in my opinion, some of the best.

Based on 33 years in the practice of Environmental Medicine, it is my opinion that Candida plays a critical role in many of the patients I have treated. Candida should be considered in every patient, especially those patients with multi-system involvement. In my experience, a therapeutic trial using systemic anti-fungal drugs is the only way to identify yeast as a causative factor in the patient’s multiple signs and symptoms.

If you are reading this, then you may be wondering about Candida (yeast) as a cause of your medical problems. So, based on my 33 years of evaluating and treating for yeast overgrowth, let me set you straight. Yes! Yeast could certainly be the cause of your disease and is often the cause of many patients’ multiple problems. There is no sign or symptom that cannot be associated with it.

Everyone has some Candida albicans because it is part of the normal flora of our intestine. It was put there to protect us, like a natural antibiotic, from pathogenic enteric organisms including Salmonella, Shigella, and Typhoid fever. Like everything in Nature, the key is balance. In our body, which is made up of around 300 trillion cells, is another body of about 300 trillion cells living within our gastrointestinal tract, made up of our microbiological or bacterial flora. This community of helpful organisms can be altered or destroyed when we take antibiotics, steroids, hormones, and an unhealthy diet rich in refined carbohydrates and sugars.

How do you know if yeast is contributing to your problems?

You can look for Candida in your stool, vaginal secretions, and even from scraping the inside of your mouth. Or, you could analyze your urine for the metabolites produced by yeast. An Organic Acid Analysis performed on your urine may reveal the presence of such metabolites as d-arabinose, citramalic and tartaric acids, and several others. These are not metabolites natural to humans, so if you find them, you know they must belong to something else living in your body, such as Candida. Organic Acid Analysis is routinely used in diagnosing our patients as a first step towards yeast eradication. Kits are available from the Center.

Most women can easily diagnose if they have yeast vaginitis by the white odorless discharge accompanied by itching. But you must remember the vagina and also the prostate in men are only opportunistic sites. ALL Candida comes from the GI tract.

If we have Candida, is it really all that harmful to the body?

Although this may be hard to believe, taking an antibiotic can alter the flora of your gut for as long as two years. This alone explains why Candida can be so damaging. The proper balance of flora in your gut provides a strong foundation for good immunity.

Candida has at least 90 antigenic foci on its outer membrane, which cross react with multiple tissues of the body in what we call autoimmunity. This is especially true for ovarian and thyroid tissues. Autoimmunity is the mechanism by which many of man’s enigmatic diseases are caused. We may be especially vulnerable to disruption of our endocrine glands’ function through this process of autoimmunity.

Candida albicans overgrowth as a cause for celiac disease or gluten intolerance is also being actively researched. In gluten intolerance, a person is unable to properly digest gluten in wheat, oats, rye, barley, spelt, kamut, or anything containing these grains. When people with gluten intolerance consume gluten-containing grains, their intestines become so inflamed the intestinal villi are gradually destroyed and the person suffers many symptoms such as diarrhea or constipation, unexplained weight loss or even weight gain, irritable bowel, skin rashes, or unresolved nutrient deficiencies. Even chronic headaches, neurological symptoms, mood swings, and changes in behavior, can be provoked by gluten intolerance, since the breakdown products of gluten adversely affect the brain and nervous system. The gliadin portion of the gluten protein is thought to be the component of gluten that is so toxic to gluten-intolerant people. A laboratory test for celiac disease measures antibodies in a patient’s blood against gliadin (anti-gliadin antibody) and against their own body’s tissue transglutaminase (anti-tissue transglutaminase antibody).

“Is Candida albicans a trigger in the onset of coeliac disease?” was the title of a research article published in the highly respected medical journal, The Lancet [reference below]. The researchers found Candida albicans contains a protein in its cell wall called “hyphal wall protein 1” or HWP1 that is very similar in its structure to components of gliadin. In addition, Candida can actually use its human host’s tissue transglutaminase to adhere to the intestinal wall. Researchers are looking at the possibility that when Candida becomes attached to a person’s intestines and their immune system tries to get rid of it, antibodies are produced that attack both gliadin and transglutaminase, since these are similar or identical to components within Candida’s cell wall. Unfortunately, these antibodies could also trigger full-blown celiac disease in the unsuspecting person. This is yet another reason why overgrowth of Candida is not to be taken lightly. The researchers went further to hypothesize that some patients who are gluten intolerant but do not improve with a gluten-free diet, might be able to improve if Candida overgrowth was effectively treated.

Dr. Billy Crook was one of the first physicians to call our attention to the dangers of Candida. When he wrote The Yeast Connection, many of us began to think that the sun rose and set on this little microorganism called Candida albicans. Dr. Crook and many other doctors paid a heavy price from the medical establishment who did not agree. But Dr. Crook was right–problems with yeast must be considered in any patient with unexplained multi-system disease.

How do you treat an overgrowth of Candida?

Dr. Crook always liked questioning his fellow physicians who were actively working with patients to overcome yeast overgrowth, in order to learn what they found to be successful treatments. I was no exception. He quoted me in many of his books as saying, “A therapeutic trial with a systemic anti-fungal drug is, in my opinion, the most effective way of identifying yeast as the cause of a patient’s problems,” and a major step in yeast eradication. If the patient improves dramatically when on the anti-fungal drug, yeast is most likely at least one of the major causes of his problems. We’ve been helping patients successfully overcome yeast-related illnesses for over 30 years.

Unfortunately it is hard to find physicians open-minded enough to look for the presence of yeast or to write a prescription for anti-fungal drugs for yeast eradication. I am often amazed to see patients coming to us from all over the country for treatment of yeast because they cannot get their own doctors to treat them for this condition.

Although treating Candida is important, preventing it is just as important. If taking antibiotics is a major cause, then how do you prevent an overgrowth of Candida if you are prescribed an antibiotic? Using large and generous doses of a well-balanced probiotic with your antibiotic is one way. Taking the anti-fungal drug Nystatin with the antibiotic is another way, but again you need a physician who understands the importance of preventing yeast overgrowth and is willing to work with you.

To make this point, I would like to share my experience specifically with children with autism. When taking the history of these children, we very often see they’ve had multiple ear infections and have been treated with multiple antibiotics, resulting in major GI flora imbalances. So it should come as no surprise that yeast becomes a major factor for these children. Although autism is a complex multi-cause disorder, I find yeast to be very prominent as a cause. Treating with a systemic anti-fungal often results in dramatic reversal of these children’s symptoms, including problems with behavior and focus. When yeast recurs many of the symptoms recur, and when treated again the signs and symptoms abate. This is the pattern often seen when yeast is a major cause and why I believe it is important to do a therapeutic trial of a systemic anti-fungal and a comprehensive program for yeast eradication.

What can you do to get started?

The Center is happy to talk with any patient who feels they might have a problem related to Candida. You can call our New Patient Coordinator, Cathy, at (843) 572-1600 to talk with her and set up an appointment for evaluation and treatment.

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All material provided on the Center for Occupational & Environmental Medicine web site is for educational purposes only. Access to the web site does not create a doctor-patient relationship nor should the information contained on the web site be considered specific medical advice for any person, patient and/or medical condition. Consult a physician regarding the application of any opinions or recommendations from this website, for any symptom or medical condition. Dr. Lieberman specifically disclaims any liability, loss or risk, personal or otherwise, that is or may be incurred as a consequence, directly or indirectly, resulting from use or application pertaining to any of the information provided on the web site.